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General NPI Number Information
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NPI Number | 1710955323
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY DERMATOLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 900 ROUTE 168 F6
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-3233
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Country | US
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Telephone | 856-227-7488
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Fax | 856-228-3476
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Provider Business Mailing Address
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Address Line | 900 ROUTE 168 F6
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-3233
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Country | US
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Telephone | 856-227-7488
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Fax | 856-228-3476
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BOOTH H DURHAM
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Credential | M.D.
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Telephone | 856-227-7488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA03237000
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License Number State | NJ
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